More Medical Treatment: Monoclonal Antibodies and Surgery

Monoclonal antibodies are antibodies against proteins in or around a cancer cell. Antibodies recognize an "invader" -- in this case, a cancer cell -- and attack it.

Trastuzumab (Herceptin) is an antibody against the HER-2 protein, a protein responsible for cancer cell growth in many women with breast cancer (about 15%-25% of breast cancers). Adding treatment with trastuzumab to chemotherapy given after surgery has been shown to lower the recurrence rate and death rate in women with HER2/neu-positive early breast cancers. Using trastuzumab along with chemotherapy has become standard adjuvant treatment for these women.

Lapatinib (Tykerb) is another drug that targets the HER2/neu protein and may be given combined with chemotherapy. It is used in women with HER2-positive breast cancer that is no longer helped by chemotherapy and trastuzumab.

Another monoclonal antibody, bevacizumab (Avastin) has been shown to have activity in the treatment of breast cancer and is used in combination with chemotherapy. This drug targets the ability of cancer cells to form new blood vessels. However, the U.S. FDA revoked its approval of this drug in November 2011, noting that those taking Avastin faced potentially life-threatening side effects without proof that the drug provided benefits in slowing tumor growth or improving longevity or quality of life.

Surgery

Surgery is generally the first step after the diagnosis of breast cancer. The type of surgery is dependent upon the size and type of tumor and the patient's health and preferences. The choice of procedures should be discussed with your health-care team as any approach has advantages and disadvantages.

Lumpectomy involves removal of the cancerous tissue and a surrounding area of normal tissue. This is not considered curative and should almost always be done in association with other therapy such as radiation therapy with or without chemotherapy or hormonal therapy.

At the time of lumpectomy, the axillary lymph nodes (the glands in the armpit) need to be evaluated for the spread of cancer. This can be done by either removing the lymph nodes or by sentinel node biopsy (biopsy of the closest lymph node to the tumor).

If a sentinel node biopsy is done at the time of lumpectomy, it may allow the surgeon to remove only some of the lymph nodes. In this procedure, a dye is injected into the area of the tumor. The path of the substance is then followed as it travels to the lymph nodes. The first node reached is the sentinel node. This node is considered most important to biopsy when evaluating the spread of the tumor.

If the sentinel node biopsy is positive, the surgeon will usually remove of all of the lymph nodes found in the axilla (armpit).

Simple mastectomy removes the entire breast but no other structures. If the cancer is invasive, this surgery alone will not cure it. It is a common treatment for DCIS, a noninvasive type of breast cancer.

Modified radical mastectomy removes the breast and the axillary (underarm) lymph nodes but does not remove the underlying muscle of the chest wall. Although additional chemotherapy or hormonal therapy is almost always offered, surgery alone is considered adequate to control the disease if it has not metastasized.

Radical mastectomy involves removal of the breast and the underlying chest wall muscles, as well as the underarm contents. This surgery is no longer done because current therapies are less disfiguring and have fewer complications.